Annals for Educators - October 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesOctober 2023Annals for Educators - October 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202310170 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsBlood Pressure Level in Late Adolescence and Risk for Cardiovascular Events. A Cohort StudyNot enough is known about the association between blood pressure (BP) in adolescence and future cardiovascular events. This retrospective cohort study used data from the Swedish military conscription register to investigate the association between BP categories in late adolescence, defined according to the American College of Cardiology/American Heart Association guidelines, and risk for future cardiovascular events.Use this article to:Review the diagnosis and treatment of hypertension. This In the Clinic review is a useful resource. Ask your learners whether they think that the results of this study should change practice to begin screening for hypertension during adolescence. Are there potential adverse consequences of such screening?Discuss how to distinguish primary hypertension from secondary hypertension.Demonstrate the correct way to measure BP, and have your learners practice it.Risk for Congenital Anomalies in Children Conceived With Medically Assisted Fertility Treatment. A Population-Based Cohort StudyPrevious studies have suggested that children conceived via the use of assisted reproductive technologies (ARTs) are at increased risk for congenital anomalies (CAs). However, underlying infertility was not always accounted for, and fertility treatments have expanded over time. This population-based cohort study examines the risk for CAs in children conceived using various types of fertility treatment, including ARTs, compared with those conceived without the use of fertility treatment among parents with and without a history of infertility.Use this article to:Invite an obstetrician-gynecologist to provide an overview of the infertility interventions currently used in practice.Discuss the strengths and limitations of the cohort study design for answering the question this study sought to answer.Review propensity score methods and the study design issues these methods are used to address.Based on these findings, how would your learners counsel a couple interested in fertility interventions?Chronotype, Unhealthy Lifestyle, and Diabetes Risk in Middle-Aged U.S. Women. A Prospective Cohort StudyEvening Chronotype, Circadian Misalignment, and Metabolic Health: Implications for Diabetes Prevention and BeyondPeople who are inclined to later sleeping times have an increased risk for diabetes. This study used the Nurses' Health Study II to examine the role of modifiable lifestyle behaviors in the association between chronotype and diabetes risk. The accompanying editorial discusses the findings and the implications for future study.Use this article and the editorial to:Review how chronotype was defined in this study, and then ask your learners whether they have a morning or evening chronotype.Poll your learners to see whether those with morning or evening chronotype report more difficulty with working overnight shifts.Discuss the limitations of this study. What types of studies would need to be done to overcome these limitations?Ask your learners whether they plan to make any changes in clinical practice based on this study.Implications of the Use of Artificial Intelligence Predictive Models in Health Care Settings. A Simulation StudyWhen Clinical Prediction Is Steering the Ship, Beware the Drift of Its WakeThere is increasing interest in incorporating prediction models into clinical practice. Because these models use information about the patient population and practice patterns to inform their predictions, changes in any of these aspects of care resulting from prior or concurrent implementation of prediction models could potentially lead to decreased prediction performance. The objective of this simulation study was to assess how common approaches to implementing clinical prediction models could influence the predictive performance of current or future models. The accompanying editorial discusses the findings and notes that monitoring and responding to drift in deployed models should be a priority.Use this article and the editorial to:Ask your learners to define artificial intelligence and to identify current uses of it in your own health system.Discuss the difference between traditional prediction models and those that use artificial intelligence. What are examples of each?Discuss why the performance of predictive models that use artificial intelligence might worsen rather than improve over time.Xylazine Adulteration of the Heroin–Fentanyl Drug Supply. A Narrative ReviewSurveillance of Xylazine Use and Poisonings Is Needed—Without Blind SpotsXylazine is an FDA-approved animal sedative that is commonly used in veterinary medicine but is not approved for human use. Xylazine began to appear in the illicitly manufactured fentanyl supply in 2016 and has significantly increased in prevalence, likely due to its low cost, easy availability, and presumed synergistic psychoactive effect. The authors use clinical experience along with the available pertinent research to review xylazine adulteration of the drug supply and provide guidance on the care of patients exposed to xylazine. The accompanying editorial discusses the importance of comprehensive surveillance of xylazine use and poisonings.Use this article and the editorial to:Ask your learners whether they have cared for patients affected by adulteration of street drugs with xylazine. How did those patients present?Review the presentation of xylazine poisoning.Discuss the appropriate approach to a patient with xylazine poisoning. Should naloxone be administered?Review the presentation and management of xylazine-associated wounds.More Protection Against Respiratory Viral Infection: Respiratory Syncytial Virus Vaccines for Adults Aged 60 Years and OlderThe U.S. Food and Drug Administration recently approved 2 vaccines for prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) in adults aged 60 years or older. This commentary describes the evidence supporting this approval and the subsequent recommendations from the Advisory Committee on Immunization Practices (ACIP).Use this article to:Invite an infectious disease specialist to your session to review the clinical presentation and diagnosis of RSV infection. Review the factors that put patients at risk for severe disease.Review the available RSV vaccines and their availability in local pharmacies.Review the current ACIP recommendations for RSV vaccination.Ask your learners how they would advise a patient who asked whether they should get vaccinated for influenza, COVID-19, and RSV at the same time.Beyond the GuidelinesWould You Screen This Patient for Cognitive Impairment? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterIn 2020, the U.S. Preventive Services Task Force assessed evidence for the benefits and harms of screening for cognitive impairment in older adults. In this article, 2 experts discuss the conclusions of that assessment, what screening tools and interventions are available, the effects of screening on patient outcomes, and whether they would recommend screening for cognitive impairment.Use this article to:Watch the patient video with your learners, and then ask them what they would recommend for this patient who is concerned about cognitive impairment.Have a neurologist join your session to review available screening tools for cognitive impairment.Watch the grand rounds video with your learners, and then have them test their knowledge by completing the quiz that accompanies the article.COVID-19COVID-19, the illness caused by SARS-CoV-2, became a worldwide pandemic in 2020. Initial clinical manifestations range from asymptomatic infection to mild upper respiratory illness but may progress to pulmonary involvement with hypoxemia and, in some cases, multiorgan involvement, shock, and death. Older adults, pregnant women, persons with common comorbidities, and immunosuppressed persons are at greatest risk for progression. Vaccination is effective in preventing symptomatic infection and reducing risk for severe disease, hospitalization, and death. Antiviral treatment and immunomodulators have been shown to benefit certain patients. This article summarizes current recommendations on prevention, diagnosis, management, and treatment of COVID-19.Use this article to:Discuss the presentation of COVID-19.Review the correct use of rapid antigen tests and PCR tests in diagnosing acute COVID-19.Ask your learners to identify risk factors for severe COVID-19 requiring hospitalization.Discuss the indications for antiviral therapy. These recommendations from the American College of Physicians may help guide the discussion. Discuss the correct prescription of antiviral agents for COVID-19. Make sure your learners are aware of this helpful resource for identifying drug interactions with nirmatrelvir–ritonavir. Have your learners role-play how they would use these recommendations to counsel a patient with acute COVID-19 who requests ivermectin.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, MACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics October 2023Volume 176, Issue 10 ePublished: 17 October 2023 Issue Published: October 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...